Ohira Suguru, Doi Kiyoshi, Kawajiri Hidetake, Dohi Masahiro, Yamamoto Tsunehisa, Watanabe Taiji, Okawa Kazunari, Yaku Hitoshi
Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan,
Gen Thorac Cardiovasc Surg. 2014 Oct;62(10):608-13. doi: 10.1007/s11748-014-0416-8. Epub 2014 Jun 10.
To evaluate the relationship between preoperative magnetic resonance imaging (MRI) findings and the occurrence of postoperative intracranial hemorrhage (ICH) in infective endocarditis (IE) patients.
Between 2002 and 2012, 30 IE patients required surgical intervention. Four patients developed and 26 patients did not develop postoperative ICH. All patients underwent preoperative brain MRI. The presence of acute brain infarction was detected by diffusion-weighted imaging (DWI), and cerebral microbleeds were detected by T2*-weighted imaging.
Two ICH(+) patients died of stroke. Preoperative patient characteristics and operative results were not significantly different. Regarding MRI findings, the presence of cerebral microbleeds or acute brain infarction alone was not significantly different between the two groups (100 vs. 29.6 %, p = 0.07; 75.0 vs. 38.5 %, p = 0.37, respectively). The concurrent presence of cerebral microbleeds and acute brain infarction was significantly correlated with the development of major ICH (75 vs. 14.8 %, p = 0.04). In multiple logistic regression analyses, the concurrent presence of cerebral microbleeds and acute brain infarction on MRI was an independent predictor of major postoperative ICH (p = 0.03, odds ratio 16.5, 95 % confidence interval 1.35-201.3).
The combination of T2*-weighted MRI and DWI may be useful to evaluate the risk of IE patients developing major postoperative cerebral bleeding.
评估感染性心内膜炎（IE）患者术前磁共振成像（MRI）表现与术后颅内出血（ICH）发生之间的关系。
2002年至2012年间，30例IE患者需要手术干预。4例患者发生术后ICH，26例患者未发生术后ICH。所有患者均接受术前脑部MRI检查。通过弥散加权成像（DWI）检测急性脑梗死的存在，通过T2*加权成像检测脑微出血。
2例ICH（+）患者死于中风。术前患者特征和手术结果无显著差异。关于MRI表现，两组之间单独存在脑微出血或急性脑梗死的情况无显著差异（分别为100%对29.6%，p = 0.07；75.0%对38.5%，p = 0.37）。脑微出血和急性脑梗死同时存在与主要ICH的发生显著相关（75%对14.8%，p = 0.04）。在多因素逻辑回归分析中，MRI上脑微出血和急性脑梗死同时存在是术后主要ICH的独立预测因素（p = 0.03，优势比16.5，95%置信区间1.35 - 201.3）。
T2*加权MRI和DWI相结合可能有助于评估IE患者发生术后严重脑出血的风险。
